Provider Demographics
NPI:1811298250
Name:COLONIAL FAMILY PHARMACY LLC
Entity type:Organization
Organization Name:COLONIAL FAMILY PHARMACY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:HEATH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-440-2271
Mailing Address - Street 1:3822 COLONIAL AVE
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16506-3826
Mailing Address - Country:US
Mailing Address - Phone:814-835-0000
Mailing Address - Fax:814-835-0900
Practice Address - Street 1:3822 COLONIAL AVE
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16506-3826
Practice Address - Country:US
Practice Address - Phone:814-835-0000
Practice Address - Fax:814-835-0900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-16
Last Update Date:2010-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP4820933336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3994705OtherNCPDP PROVIDER IDENTIFICATION NUMBER